Rethinking Healthcare... Completely

from the about-time dept

A few months back, after meeting UCLA professor David Levine at the Cato Institute conference on copyrights, I read his book, Against Intellectual Monopoly (actually a large part of it I read on the flight home from that trip). Of particular interest to me was chapter 9, on the pharmaceutical industry -- as that's often the industry held up as the perfect example of why aggressive intellectual property laws in patents makes sense. The chapter points out plenty of examples of why things aren't as great as they seem. As with any monopoly you get some pretty unwanted actions that are more harmful than helpful -- and that's especially true when it comes the tricky games pharmaceutical companies use to make sure they keep their monopoly. Some evidence of that was seen just recently in the scandal at Bristol-Myers Squibb. What I hadn't realized, was just how relevant this would all be when reading Andy Kessler's new book, The End of Medicine. I've known Andy for a while, so he and I had discussed this book over lunch back when he started writing it in 2005 -- and in our discussions I always said that it would be the insurance companies that made whatever dreams of "reinventing" healthcare more difficult. However, Andy insisted that that based on what he was learning, things would get so cheap (following the Moore's Law pattern) on many of these technologies, that insurance would be taken out of the equation. Instead, the real obstacle could very well be the pharmaceutical industry and their monopolies.

The book probably isn't what you think it is. It's not about reforming the healthcare system, and it's not just about new technologies that make healthcare better. It's really about recognizing that the way we think about healthcare may be fundamentally flawed. That is, we're very focused on curing problems, not preventing them (despite the old ounce of prevention vs. pound of cure line). A big part of this problem is that the technology just hasn't been good enough yet to see inside our bodies clearly enough to really understand what's going on. That makes it hard to actually prevent stuff when you don't know what needs preventing. However, the technology on that front is starting to change, and it's possible that it'll go down the cost/power curve of traditional computer technology (meaning: wow, watch out). But, even more interesting is the total lack of money then going into prevention and early detection using technology. Instead, all the money goes into pharmaceuticals, where the big monopoly payoff is. On top of that, these early detection techniques (which could save a ton of lives, and, as the book notes, have great unexpected benefits on the economic side) get short-changed -- especially as the FDA requires them to follow the same procedure as drug development, even though they're not drugs.

The book itself is a quick and fun read, even with the "weighty" subject matter, as per Kessler's usual writing style. Reading it, I became equally frustrated at the stupid and unnecessary barriers in the way of some of these technologies and optimistic at the potential for where all of this could go (and how quickly). Andy was kind enough to allow us to publish an excerpt of the book, discussing "the physical of the future," which you can find after the jump (if you're reading in an RSS reader or on the front page, click through). The book has been getting some great reviews, and Andy says he's received some hate mail from doctors... so you know he's doing something right.Chapter 34 - Physical of the Future
Excerpt from: The End of Medicine: How Silicon Valley (And Naked Mice) Will Reboot Your Doctor, by Andy Kessler

OK, I get it. This is the physical of the future. Sticking out your tongue and getting a finger up the wazoo is something some stooge might do, Dr. Howard, Dr. Fine and Dr. Howard back in the 1930's.

256 slice scanners, faster than your heartbeat, just might be the magic pill of diagnosis. It's as if doctors will be saying I was blind before I could see. Blind as a bat. Six blind doctors feeling around an elephant and describing a wall, spear, snake, tree, fan and a rope. Looking for clues in all the wrong places. Measuring cholesterol and blood pressure is like reading the outside temperature and humidity from inside your house and guessing if it's raining. Open the window, stick your goddamn hand outside and know for sure.

These scanners will spit out gigabytes of data, thousands of slices. We already know we can't afford radiologists to sift through all this data, not at their usual fees of $149 for 60 seconds.

But so what? Technology like R2 can help. It can flag anything suspicious. False positives will be a lot lower than the discredited scans of 2000. Higher resolution and higher speeds should mean artifacts go down, not up. Expertise embedded in silicon detector rows, 3D rendering and computer aided detection - not the Dr. Finkelsteins of the world. Again, not until we need him.

How much do these scans have to cost to become widespread? $500? $100? $20? It almost doesn't matter. The cost savings comes over time. Spread the R&D over millions and you get scale. It works. Patients as products of medicine will have to wait - thank you Blue Cross, you cheap bastards. I read there are upwards of 2 million heart procedures done each year, about half in the U.S. Scanning 300 million Americans at even $100 a throw is $30 billion, vs. $15,000 for a stent times a million procedures or $15 billion. It's cheaper for your symptoms to show up in real life - clutching chest, can't breath, life flashing in front of your eyes - then in a few gigs of a virtual scan.

* * *

Patients as consumers of medicine, well, that's a different story.

Let's see, I can buy that new Mustang or I can have a heart scan and not worry about dropping dead at work. Hmm. I have no doubt that lot's of folks will take the Mustang behind door number 2, but if we can spend billions on low carb diets and Special K cereal and Eggbeaters, let alone Viagra and Botox, parting with some discretionary cash for a life saving heart scan doesn't seem so far fetched.

No, this digital divide isn't going to be between the haves and have nots. Like PCs and cellphones, I suspect it will all get cheap enough. No, it's more the want-to-knows and the don't-want-to-knows.

If the end game of all this is more control of our healthcare, like managing your own money, some people are going to be good at it and others aren't. Maybe in some ways Darwinian - you become dependent on your own research and effort. It's going to take some combination of personality, character and intelligence just to be able to handle it - fight back the nausea when someone shows you your guts and glory.

I admit to sweating through my BVDs waiting for the results of my heart scan. I still see puppies being pulled out of a Boston Terrier whenever I'm asked to confront anything medical. It's so, like, totally grodie.

But I suspect I just had to get over it. If I want to cheat a little bit, live a little longer than predetermined by my parental gene inheritance, I needed to wake up and smell the blood. Still, this is not a small obstacle to acceptance of this new medicine. Would you like to know when you're going to die? What if these new scanning guys threw a party and no one showed up?

* * *

But plenty will. The opposite question is what if half of those million heart procedures are no longer necessary because something was detected early enough to treat in other ways? That's a lot of hospital beds and cardiologists and nurses with nothing to do. But that's exactly what is going to happen as scanning gets cheap enough, as Dr. Goldman's 256 slice machine gets utilized 24/7. He is the anti-hospital, anti-doctor doctor.

Then, do we really need doctors - at least doctors as they exist today?

Reader Comments

It's not the insurance companies...

The huge resistance to changing the healthcare industry comes from doctors and med schools.

My company (www.pkc.com) makes medical diagnostic software. The premise is that doctors cannot keep it all in their heads, but med schools and the medical profession at large teach and preach this egotistical attitude. Think of all the hype in the late 70's and early 80's about seeking a second opinion. How dare you question your doctor's judgement!

Doctors need to have ready access to a large array of knowledge and they need to think combinatorially. Humans cannot think combinatorially and they cannot hold the body of medical knowledge in their heads. The pharmaceutical firms just provide one easy out for them. Doctors don't have time to know everything, but hey! If you're patient has heartburn, just give them this purple pill! Of course, this also underscores the GOTTA HAVE IT RIGHT NOW attitude that is becoming the norm.

Do we need doctors? Most certainly. But they have to change with the times if we are to avert some real disasters.